Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use

BACKGROUND: Millions of individuals have used illicit anabolic-androgenic steroids (AAS), but the long-term cardiovascular associations of these drugs remain incompletely understood. METHODS: Using a cross-sectional cohort design, we recruited 140 experienced male weightlifters 34 to 54 years of age, comprising 86 men reporting >= 2 years of cumulative lifetime AAS use and 54 nonusing men. Using transthoracic echocardiography and coronary computed tomography angiography, we assessed 3 primary outcome measures: left ventricular (LV) systolic function (left ventricular ejection fraction), LV diastolic function (early relaxation velocity), and coronary atherosclerosis (coronary artery plaque volume). RESULTS: Compared with nonusers, AAS users demonstrated relatively reduced LV systolic function (mean +/- SD left ventricular ejection fraction = 52 +/- 11% versus 63 +/- 8%; P < 0.001) and diastolic function (early relaxation velocity = 9.3 +/- 2.4 cm/second versus 11.1 +/- 2.0 cm/second; P < 0.001). Users currently taking AAS at the time of evaluation (N=58) showed significantly reduced LV systolic (left ventricular ejection fraction = 49 +/- 10% versus 58 +/- 10%; P < 0.001) and diastolic function (early relaxation velocity = 8.9 +/- 2.4 cm/second versus 10.1 +/- 2.4 cm/second; P=0.035) compared with users currently off-drug (N=28). In addition, AAS users demonstrated higher coronary artery plaque volume than nonusers (median [interquartile range] 3 [0, 174] mL(3) versus 0 [0, 69] mL(3);P=0.012). Lifetime AAS dose was strongly associated with coronary atherosclerotic burden (increase [95% confidence interval] in rank of plaque volume for each 10-year increase in cumulative duration of AAS use: 0.60 SD units [0.16-1.03 SD units]; P=0.008). CONCLUSIONS: Long-term AAS use appears to be associated with myocardial dysfunction and accelerated coronary atherosclerosis. These forms of AAS-associated adverse cardiovascular phenotypes may represent a previously underrecognized public-health problem.